Test 1 Review
Test 1 Review NUR 349
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This 12 page Study Guide was uploaded by Nicole Raynor on Thursday August 25, 2016. The Study Guide belongs to NUR 349 at Molloy College taught by Paraszczuk in Fall 2016. Since its upload, it has received 6 views. For similar materials see HumanistChldFam in Nursing and Health Sciences at Molloy College.
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Date Created: 08/25/16
Ear, Nose, Throat, Respiratory Dysfunctions Review Chapter 45 Respiratory Assessment Nasal flaring is indicative of respiratory distress in infants Retractions can be seen Pediatric Differences Infants – obligatory nose breather Newborn – irregular breathing pattern Preterm infant – insufficient surfactant Infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system because mucus and edema obstruct the small airways Otitis Media – effusion/infection or blockage of the middle ear Prevention of complications/reoccurrence o Reduce second hand smoke Acute Otitis Media Bacterial or viral Earache, bulging, opaque membrane, drainage (with perforation) Treatment – select children 6 months of age or older with acute otitis media are treated by initiating symptomatic treatment and observation for 48 to 72 hours Broad range of antibiotics Otitis Media with Effusion Monitor for hearing loss Bacterial Pharyngitis Antibiotics – parent should give penicillin 3 times per day for 10 days Tonsillectomy Post Op o Monitor the child’s airway/watch for bleeding Breathing difficulty Excessive swallowing – indicates bleeding in back of the throat Vomiting bright red blood o Promote comfort – Offer the child apple juice Obstructive Sleep Apnea Disordered breathing during sleep characterized by recurrent episodes of partial or complete upper airway obstruction May exhibit – snoring, labored breathing, retractions during sleep with breathing pauses followed with a gasp, choke, movement Interventions: o Stimulate the infant by gently tapping the foot o Have resuscitative equipment available o Maintain a neutral thermal environment Croup Syndromes Characterized by hoarseness, “barking” cough, inspiratory stridor Interventions: o Take the child into the cool, humid, night air may relieve mucosal swelling and improve symptoms Acute LTB (laryngotracheobronchitis) Clinical Manifestations: o Inspiratory stridor* Nursing Considerations: o Reduce anxiety – encourage mother of toddler to stay at the bedside as much as possible because the presence of the child’s mother will reduce anxiety and ease the child’s respiratory efforts Acute Epiglottitis/ Epiglottitis Cardinal Symptoms: drooling, dysphagia (can’t swallow), dysphonia, distressed respirations with inspiratory stridor, tripod positioning, no cough, anxious Medical emergency – prepare intubation equipment and call physician Do NOT leave the child unattended Prevention: Hib vaccine Foreign Body Aspiration Latex balloons account for a significant number of deaths from aspiration every year Heimlich above age 1 Below age 1 – back blows Infections of the Lower Airways Asthma o Chronic, nonproductive cough, diffuse wheezing during the expiratory phase of respiration o Exercise can trigger attack o Children can usually play any type of sport if their asthma is well controlled o Short acting beta2 adrenergic agonist o Peak flow meter – it is used to monitor the child’s breathing capacity Bronchitis/Pneumonia o Pneumonia – offer the child warm liquid drinks (helps loosen secretions) Bronchiolitis Nursing Considerations o Supportive care – give cool humidified oxygen Pertussis – Whooping Cough Very contagious Can look like RSV – but different because it is caused by bacteria Nursing Considerations o Cohort and infection control measures (droplet and contact precautions) Cystic Fibrosis An inherited multisystem disorder characterized by widespread dysfunction of the exocrine glands o Abnormal secretions of thick, tenacious mucus o Obstruction and dysfunction of the pancreas, lungs, salivary glands, sweat glands, and reproductive organs Autosomal Recessive Trait o Inherits defective gene from both parents o Both parents must be carriers to transmit to child o If both parents carry – 25% change of producing a CFaffected child Clinical Features: o Increased sweat electrolytes Abnormally high levels of NaCl in the sweat Pulmonary: o Tenacious secretions are difficult to expectorateobstruct the bronchi/bronchioles provides a media for bacteria to grow o Atelectasis with hyperinflation (air gets trapped) o Decreased oxygen and CO2 exchange results in hypoxia, hypercapnea, acidosis o Manifestations: Barrel shaped chest, cyanosis, clubbing of fingers and toes GI: o Thick secretions block ducts prevents pancreatic enzymes from reaching duodenum o Impaired digestion/absorption of fat (steatorrhea) o Manifestations: Newborns – meconium ileus (first stool – thick tarry bowel movement that has no shape – within 24 hours) either the child does not stool at all because of ileus or they pass meconium club (not normal) earliest recognizable manifestation / abdominal distention Older children – large bulky, frothy, malodorous stool, failure to pass stools Other: dehydration, electrolyte, pH imbalance o Diagnosis: Sweat Chloride test – greater than 60 mEq/L – confirms diagnosis Stool fat/ enzyme analysis important to identify how much replacement enzymes are needed o Management: Replacement of pancreatic enzymes taken with meals Give enzymes with meals/snacks for adequate absorption of nutrients Can be mixed with small amounts of nonacidic foods if the child cannot swallow the pancreatic enzyme capsules – applesauce High protein, high calorie diet Vitamin supplementation A, D, E, K fat soluble vitamins are poorly absorbed because of deficient pancreatic enzymes in children with cystic fibrosis; supplements are necessary Nursing Considerations: o Respiratory care** cautious use of oxygen Patient can get CO2 narcosis o Education: Teach parents to adjust enzyme dosage according to stool formation – when there is constipation, less enzyme is needed; with steatorrhea (fat) – more enzyme is needed for digestion of nutrients Nursing Care of Families & Children Chapter 34 Review Family – Centered Care: o Recognize that family as constant in child’s life and pivotal to child’s wellbeing always include the family Emergency Situations: o Include parents as partners in providing care for the child o When dealing with parents who are upset, it is important not to be defensive or attempt to justify anyone’s actions o Encourage parent to talk about feelings o Use simple words and short sentences when people are upset o Direct angry parent to a quiet area o #1 cause of unintentional injuries in children younger than 19 is motor vehicle crashes! o Suspicion for maltreated child Injuries is unusual for the child’s age o Choking: Heimlich maneuver – for a conscious child older than 1 year of age Abdominal thrusts – when child is unconscious 5 Back blows – infant with an obstructed airway 5 chest thrusts – following back blows for infant Communicating with Children o Infants (06 months) Stranger anxiety, no object permanence Encourage parents to hold infant o Toddlers (13 years old Object permanence Allow child to hold a favorite toy or blanket (comforting) Parents should remain with the child as much as possible to calm and reassure the patient o Preschoolers (35 y/o) Use positive terms and avoid terms such as “shot” and “cut” Have literal interpretations Should be told about procedures immediately before they are done o SchoolAge (612 y/o) Need explanations, reasons Body integrity o Adolescents (1218 y/o) Abstract thinking – provide clear explanations and encourage questions Provide privacy Stress of Hospitalization o Young child may make phone calls and get advice from friends about what they should do Assessment: Start with a rapid cardiopulmonary assessment o Evaluate the general appearance – color activity, responsiveness, position (looks good vs. looks bad) If the patient “looks bad” color pale, cold extremities, lethargic If the patient “looks good” capillary refill less than 2 seconds, unwilling to separate from parents (separation anxiety, expected) o Evaluate: ABCDEs Airway (always maintain a patent airway) Breathing Circulation D (level of consciousness) Exposure Respiratory: o Take respiratory rate first because other measurements of vitals can be upsetting to the child! o Preschool child with a respiratory rate of 10 breaths per minute should be recognized that respiratory failure is likely A normal respiratory rate is 3060 breaths per minute o Abdominal breathing in a 2 year old child is a normal respiration o Nasal flaring/grunting is a sign of hypoxia Blood Pressure: o Hypotension is a late sign of shock in children o The lower limit for systolic blood pressure for a child more than 1 year old is 70 mmHg plus two times the child’s age in years Ex: 6 year old child 6 x 2 = 12 70 mmHg + 12 = 82 mmHg lowest systolic reading of 58 mmHg hypotension alert the physician about the systolic pressure Autism Review Chapter 54 Intellectual Impairment Parents should be counseled on a child who is diagnosed, that in most cases, a specific cause has not been identified; it may be caused by a variety of factors Early detection of cognitive disorders can be facilitated through assessment of development at each wellchild examination After a child is diagnosed with a developmental delay, families typically experience a cycle of grieving that is repeated when developmental milestones are not met Cognitive dysfunction o Limited ability to anticipate danger At risk for injury Preadolescents who have a cognitive dysfunction may have normal sexual development without the emotional and cognitive ability to deal with it. o Important to assist the family and child through this developmental stage Safety is a number one priority when selecting toys for a child with a intellectual or developmental ability To facilitate socialization – provide peer experiences, such as scouting when older Preschool children – may see Developmental delays, selfinjury, fecal smearing, severe temper tantrums Autism Teaching – onset usually occurs before 3 years of age Communication (impaired) – child may exhibit monotone speech and echolalia (repetition of words) o Inappropriate volume, pitch, rate, rhythm, intonation Daytime care setting o A specialized program that facilitates interaction by the use of behavioral methods Help parents cope by explaining that child may have an extremely developed skill in a particular area Hospitalized with asthma – nurse should plan care so that the child’s routine habits and preferences are maintained o Autistic children are often unable to tolerate even slight changes in routine Behaviors associated with autism: o Child flicks the light in the exam room on and off repetitiously o Has a flat affect o Mother reports that the child has no interest in playing with other children Nursing Considerations for Hospitalized Child Chapter 35 Review Emergency Hospitalization: o Poses the greatest challenge to the nurse working with a child and family Involves: limited time for preparation both for the family and child situations that can cause fear for the family that the child may die or be permanently disables high level of activity which can foster further anxiety o Observation for 24 hours in an acute setting is often appropriate for children because they become ill quickly and recover quickly Stages of Separation Anxiety: o Protest: child may appear angry and upset If patient kicks, cries and clings to parent – this is a normal response to the stress of hospitalization o Despair: child becomes quiet, withdrawn, apathetic o Detachment Stressors of Hospitalization: Infants: Encourage someone to stay with them – otherwise they can become detached Loss of control: feeding, toileting, playing and bedtime Nurse should remember that each of these activities may have associated rituals and routines and that the child may show some regression in these areas – importance of daily routines Neonate – offer them a pacifier inbetween feedings Toddlers (13 yrs. Old): Most at risk for stressful experience in the hospital Separation from parent is a major stressor! Deep breathing exercises: blowing bubbles Autonomy – encourage them to do things for themselves) feeding self, putting on their own socks) Daily routines and rituals – following the child’s usual routines for feeding and bedtime helps a hospitalized toddler feel a sense of control Very negative Preschooler (35 yrs old) Loss of control: Give choices Allow the child to decide which color arm board to use with IV, if crying, screaming, and resisting having an IV restarted Maintain normal routine – cooperation will increase and anxiety will decrease Regression: If child used to sleep through the night and now awakens at intervals after a short hospitalization – reassure the parent that regressive behavior is normal after a hospitalization and is usually short term Egocentric – magical thinking is typical of this age Preschoolers may believe that their illness is somehow related to a thought or deed I was bad, that’s why I got sick Simple explanations of treatment and encourage child to visit hospitalized siblings School Age child (612 yrs. Old) Fear of body disability and death – recognize that death is permanent (younger school children do not know how to cope with this well) Wants to know the reason for tests and procedures Allow child to participate in injection play – for child who has to undergo frequent blood work, injections, IV therapy, or any other therapy involving syringes and needles Boredom as the child gets better, they start to get bored (is stressful) If the child is laying there and seems bored try interesting them in something else Adolescent (1218 yrs. old) Major stressor – is separation from peers! Encourage peers to call and visit when the adolescent’s condition allows During a prolonged hospitalization: o Encourage parents to bring in homework and schedule study times o Allow the adolescent to wear street clothes o Encourage parent to bring in favorite foods Maintaining a Safe Place o Intrusive procedures should take place in a treatment room, not the child’s room Assessment of the family o Ask, “How has your child’s hospitalization affected your family?” o Effects of Siblings: Being cared for by non relatives or outside of the home Receiving little information about their ill brother or sister they are going to fill in the information for themselves and can be much worse that what is actually going on Isolation o Potential for sensory deprivation Parental Presence During Procedures o Determine extent to which parents want to be involved o Respect their wishes Medication Administration Review Chapter 38 Absorption of medications: o Pancreatic enzyme activity is variable in infants for the first 3 months of life as the gastrointestinal system matures. Medications that require specific enzymes for dissolution and absorption might not get digested to form suitable for intestinal action Topical Medication: o When administering topical medication compared with an adolescent, nurses should remember that: o Infants have a thinner stratum corneum that absorbs more medication Oral medication: o If a child can not take a tablet, find out if the medication is available in liquid form o Tablets should not be crushed without knowing whether it will alter the absorption, effectiveness, release time, or taste. o To ensure accuracy, a calibrated syringe without a needle should be used to prepare a liquid dosage less than 5 mL o Apple sauce should be used to mix with medication to prevent the child from developing a negative association with an essential food, so a nonessential food such as applesauce is best o To avoid aspiration – administer the medication with a needleless syringe placed along the side of the infant’s tongue IM injections: o Maximum safe volume that a neonate can receive in an intramuscular injection is 1.0 mL o 6 month old infant should be given an IM injection in the vastus lateralis o 18 months and older should be given an IM injection in the ventrogluteal dorsogluteal muscle does not develop until a child has been walking for at least 1 year o insert the needle quickly, using a dartlike motion IV medications: o When administering an IV piggyback medication to a preschool child, the nurse should use a Smart pump if available Used to facilitate safe intermittent infusion of iv medications To assist in the prevention of medication errors o Buterol and/or IV pump Purpose is to avoid fluid overload o Nurse should assess and document the condition of the IV site every hour Subcutaneous injections o Should never be given in areas of edema because absorption is unreliable (patient with cellulitis) o A short needle (no more than 1/2 to 5/8 inch) needle should be used o Avg. 0.5 mL o Skin is pinched up to raise the fatty tissue away from the muscle Ear Medication: o Medication should be at room temperature because cold solutions in the ear will cause pain o For children younger than 3 years the pinna (lower lobe), of the ear should be pulled back and down to straighten the ear canal o Tragus should be massaged to ensure that the drops reach the tympanic membrane o Child 3 years and older – pinna is pulled up and back Administering Eye Drops o Place in the conjuctival sac that is formed when the lower lid is pulled down Double check the dosage calculation for: o Insulin, anticoagulants, narcotics
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